The Institute for Healthy Communities (Institute), a 501(c)(3) non-profit organization and strategic partner of The Hospital & Healthsystem Association of Pennsylvania (HAP), will work with hospitals and health systems that include in the clinical practice of caring for dying patients advanced palliative care procedures and facilities. The primary objective of this approach is to promote models of hospital-based palliative care as centers of learning for other hospitals that struggle to strengthen an existing service. The centers of learning will share challenges and successes encountered in the unit's development and how these findings were translated into clinical practices and integrated into a palliative care program. The practice models were identified based on their ability to illustrate the facilities' capacity to influence the whole organization and its delivery of health care, to measure and evaluate the impact of improvement efforts. In Phase I, three Pennsylvania-based hospitals will open their palliative care units to visitors for site visits, creating learning environments that welcome questions for clinical, operational, and business staff related to the development and maintenance of the unit. HAP realized that a large percentage of patients spend the end of their lives in hospitals more often than in any other setting and hospitals have a unique role in assisting patients throughout the dying process. Recognizing that palliative care services can be better utilized, the Senior Medical Advisor of HAP organized the training of clinicians from its member hospitals with the Education for Physicians on End-of-life Care (EPEC) curriculum and trained more than 150 caregivers, creating a network of 40 hospitals committed to improving palliative care in their organizations. The hospitals identified as learning centers are members of this palliative care network and leaders in the development of palliative care units. Phase II will expand these learning environments nationally to identify recipients of the American Hospital Association's (AHA) Circle of Life Award that honors innovative programs that have improved the care people receive near the end of their lives in hospital, hospice, nursing home, or home. This expansion over time will include national participants and target evidence-based change in care to a broad range of hospital settings delivering care to a large number of people over a wide geographic area. Another objective is to create a national network of professionals that prioritize quality palliative care and apply evidence-based research to practice. A tool will be developed to measure outcomes including length of stay, patient satisfaction and financial implications of hospital-based palliative care.